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1. A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study

Author

Cillara, Nicola, Podda, Mauro, Cicalò, Enrico, Sotgiu, Giovanni, Provenzano, Maria, Fransvea, Pietro, Poillucci, Gaetano, Sechi, Raffaele, Deserra, Antonello, DʼAgostino, Francesca, Margiani, Carla, Scabini, Stefano, Pertile, Davide, Rosa, Raffaele De, Prosperi, Paolo, Bruscino, Alessandro, Bella, Annamaria Di, Casati, Massimiliano, Laface, Letizia, Abate, Emmanuele, Frontali, Alice, Bonomi, Alessandro Michele, Ferrario, Luca, Mucilli, Felice, Barone, Mirko, Borghi, Felice, Sasia, Diego, Giraudo, Giorgio, Puzziello, Alessandro, Loffredo, Andrea, Steccanella, Francesca, Donnarumma, Elio, Galleano, Raffaele, Malerba, Michele, Runfola, Matteo, Agus, Marcello, Fortunato, Federica, Calò, Pietro Giorgio, Medas, Fabio, Canu, Gian Luigi, Stella, Marco, Ferrara, Francesco, Baldi, Caterina, Benuzzi, Laura, Pisanu, Adolfo, Saba, Alessandra, Gessa, Emanuela, Muratore, Andrea, Calabrò, Marcello, Cuzzola, Bruno, Garino, Mauro, Marafante, Chiara, Farfaglia, Roberto, Pandolfo, Gianpiero, Pata, Giacomo, Lantone, Giulio, Marino, Fabio, Perrone, Fabrizio, Scognamillo, Fabrizio, Delogu, Daniele, Tilocca, Pier Luigi, Frena, Antonio, Malpaga, Anna, Bertelli, Giacomo, Memeo, Riccardo, Ferraro, Valentina, Libia, Annarita, Sarro, Giuliano, Marconi, Matteo, Nava, Samuele, Pierpaolo, Bordoni, Fleres, Francesco, Clarizia, Guglielmo, Alfieri, Sergio, Rosa, Fausto, Longo, Fabio, Restini, Enrico, Cianci, Pasquale, Capuzzolo, Sabino, Anania, Gabriele, Bombardini, Cristina, Urbani, Alessia, Bona, Davide, Aiolfi, Alberto, Lastraioli, Caterina, Paola, Massimiliano Di, DallʼOglio, Anna, D’Eletto, Marco, Capelli, Patrizio, Conti, Luigi, Luzietti, Enrico, Banchini, Filippo, Manca, Giuseppe, Calo, Gabriele’, Centomze, Antonella, Andreano, Mauro, Sullo, Pasquale, Giuseppina, Oliva, Anastasi, Alessandro, Canonico, Giuseppe, Nelli, Tommaso, Trompetto, Mario, Gallo, Gaetano, Clerico, Giuseppe, Arganini, Marco, Palmeri, Matteo, Bonuso, Claudio, Mirabella, Antonello, Marino, Marco V., Vaccarella, Gianpaolo, Salzano, Francesco, Meccariello, Renato, Mastrorilli, Maurizio, Campanile, Fabio Cesare, Foti, Nicola, Angelis, Monica De, Palma, Giovanni Domenico De, Aprea, Giovanni, Palomba, Giuseppe, Milone, Marco, Capano, Mariana, Manigrasso, Michele, Baldazzi, Gianandrea, Cassini, Diletta, Epifani, Angelo Gabriele, Bottino, Vincenzo, Canfora, Alfonso, Ferronetti, Antonio, de Manzini, Nicolò, Biloslavo, Alan, Fracon, Stefano, Filauro, Marco, Barberis, Andrea, Azzinnaro, Antonio, Oliva, Alba, Razzore, Andrea, Maira, Lorenzo Di, Bima, Carlo, Gibin, Enrico, Peluso, Chiara, Perrotta, Nicola, Celiento, Marta, Scorzelli, Marco, Tuveri, Antonio, Madeddu, Francesco, Fois, Claudia, Russello, Domenico, Latteri, Saverio, Sofia, Maria, Rio, Paolo Del, Cozzani, Federico, Giuffrida, Mario, Mariani, Pierpaolo, Giussani, Martina, Ansaloni, Luca, Maestri, Marcello, Tartaglia, Giuseppe, Caricato, Marco, Capolupo, Gabriella Teresa, Carannante, Filippo, Gambino, Giovanni, Bertino, Vanessa, Bonilauri, Stefano, Frazzetta, Giuseppe, Amodio, Pietro Maria, Siena, Teresa De, Zanzi, Federico, Guariniello, Anna, Rocco, Giuseppe, Mancini, Stefano, Sagnotta, Andrea, Solinas, Luigi, Porta, Andrea, Sambucci, Daniele, Monti, Eleonora, Quaglino, Francesco, Mantova, Serena, Fiore, Alessia, Costi, Renato, Virgilio, Edoardo, Montali, Filippo, Catarci, Marco, Apa, Daniela, Bertoldi, Innocenzo, Camandona, Michele, Bossotti, Maurizio, Palagi, Silvia, Doria, Emaunele, Caltagirone, Alice, Balani, Alessandro, Petronio, Barbara, Terranova, Susanna, Martuzzi, Federica, Romeo, Carlo, Carluccio, Raffaele, Neri, Silvia, Auriemma, Pasquale Pio, Prestigiacomo, Giorgia, Sala, Stefano, Colli, Francesco, Marini, Pierluigi, Cosimo, Carla Di, Gattolin, Andrea, Rimonda, Roberto, Travaglio, Elisabetta, Cotsoglou, Christian, Granieri, Stefano, Chierici, Andrea Piero, Tamini, Nicolò, Pitoni, Ludovica, Vico, Eleonora, Altomare, Donato Francesco, Martines, Gennaro, Tomasicchio, Giovanni, Coppola, Massimiliano, Aprile, Giovanna, Sau, Paolo, Papa, Mauro Del, Manzi, Fulvio, DʼAmata, Gabriele, Cocorullo, Gianfranco, Venturelli, Paolina, Carollo, Giuseppe, Tondolo, Vincenzo, Dore, Andrea, Giorgio, Danilo Di, Gusai, Giovanni Pietro Paolo, Salaris, Claudia, Sanna, Silvia, Pignata, Giusto, Andreuccetti, Jacopo, DʼAlessio, Rossella, Massani, Marco, Tutino, Roberta, Viola, Vincenzo, Stella, Luigi Persico, Diana, Massimo, Sampietro, Gianluca Matteo, Merlini, David Alessio, Sica, Giuseppe, Bagaglini, Giulia, Manzia, Tommaso Maria, Siracusa, Leandro, Tisone, Giuseppe, Ercolani, Giorgio, DʼAcapito, Fabrizio, Pietrantonio, Daniela Di, Fiscon, Valentino, Portale, Giuseppe, Cipollari, Chiara, Sorrentino, Mario, Piccolo, Roberta, Cojutti, Alessandro, Canova, Gualtiero, Nicotera, Antonella, Zago, Marcello, Montis, Giorgio De, Castaldi, Fabio, Morelli, Maria Morena, Parma, Emilio, Paolini, Claudia, Marco, Giovanni De, Elter, Chiara, Feo, Carlo V., Fabbri, Nicolò, Severi, Silvia, Nasto, Aurelio, Patrone, Renato, Conti, Lorenzo, Rizzi, Andrea, Broggi, Luca, Danelli, Piergiorgio, Cammarata, Francesco, Fiore, Luigi, Grande, Michele, Campanelli, Michela, and Grande, Simona

Published
2023
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2. Predictive factors of intestinal necrosis in acute mesenteric ischemia

Author

Canfora Alfonso, Ferronetti Antonio, Marte Gianpaolo, Maio Vittorio Di, Mauriello Claudio, Maida Pietro, Bottino Vincenzo, Aprea Giovanni, and Amato Bruno

Subjects
acute mesenteric ischemia, irreversible transmural intestinal necrosis, explorative laparotomy, predictive factors, Medicine
Abstract

Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory.

Published
2019
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3. A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)

Author

Podda, Mauro, Serventi, Fernando, Mortola, Lorenzo, Marini, Stefano, Sirigu, Danilo, Piga, Michela, Pisano, Marcello, Coppola, Massimiliano, Agresta, Ferdinando, Virdis, Francesco, Di Saverio, Salomone, Cillara, Nicola, Balestra, Francesco, Ottonello, Roberto, Lai, Antonio, Piro, Silverio, Argenio, Giulio, Gemini, Sergio, Pala, Miriam, Piras, Mario, Erdas, Enrico, Nicolosi, Angelo, Gordini, Luca, Podda, Francesco, Pisanu, Adolfo, Atzeni, Jenny, Poillucci, Gaetano, De Nisco, Carlo, Casciu, Luigi, Piano, Maurizio, Labate, Salvatore, Saba, Luca, Aresu, Simona, Azzinnaro, Antonio, Ioia, Giovanna, Turri, Luciano, Pulighe, Fabio, Anania, Marco, Canfora, Alfonso, Bottino, Vincenzo, Piazza, Diego, Luridiana, Gianluigi, Serra, Piergiorgio, Saba, Alessandra, Tuveri, Antonio, Pinna, Giovanni, Piredda, Antonella, Madeddu, Francesco, Caneva, Patrizia Dalla, Delogu, Daniele, Saliu, Antonella, Cogoni, Gianfranco, Deserra, Antonello, Pau, Renata, Cossu, Sergio, Canu, Luisa, Marcias, Gianni, Garau, Franco, Loi, Salvatore, Bellisano, Giulia, Presenti, Luigi, Maccioni, Antonio, Norcia, Giorgio, Piras, Emanuele, Fiume, Stefania, Pitzalis, Antonella, Bianco, Paola, Cappai, Mariangela, Cadeddu, Flavio Nicola, Manca, Alessandra, Occhioni, Giovanni, Rossi, Arianna Magoni, Rizzo, Salvatore, Centonze, Maurizio, Portolano, Vincenzo, Barbareschi, Mattia, Barrasi, Elena, Martorana, Martina, Ferro, Franca, Casarini, Claudia, Stella, Giorgio, Generoso, Paola, Rossi, Sabina, Abelli, Fabrizio, Casula, Laura, Gerardi, Chiara, Bertele’, Vittorio, and The ACTUAA Study Collaborative Working Group

Published
2017
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4. IPOD Study: Management of Acute Left Colonic Diverticulitis in Italian Surgical Departments

Author

Sartelli, Massimo, Binda, Gian Andrea, Brandara, Francesco, Borasi, Andrea, Feroci, Francesco, Vadalà, Salvatore, Labricciosa, Francesco M., Birindelli, Arianna, Luridiana, Gianluigi, Coccolini, Federico, Di Saverio, Salomone, Catena, Fausto, Ansaloni, Luca, Campanile, Fabio Cesare, Agresta, Ferdinando, Piazza, Diego, Anania, Gabriele, Caproli, Emanuele, Gasparrini, Marcello, Bordoni, Pierpaolo, Lucchi, Andrea, Scabini, Stefano, Picardi, Biagio, Sarro, Giuliano, Piccinini, Alice, Bedin, Natalino, Bussotti, Alessandro, De Angelis, Renato, Baiocchi, Gian Luca, Andreotti, Antonella, Cillara, Nicola, Petronio, Barbara, Grimaldi, Sergio, Biancafarina, Alessia, Somenzi, Dario, Costanzi, Andrea, Marvaso, Alberto, Canfora, Alfonso, Vasquez, Giorgio, Chiodo, Carlo, Nano, Mario, Cavicchi, Angelo, Ruffato, Alberto, Baccari, Paolo, Polastri, Roberto, Marsanic, Patrizia, Portale, Giuseppe, Gordini, Luca, Abongwa, Hariscine K, Pili, Michela, Turati, Luca, Nusca, Vittoria, Guercioni, Gianluca, Delogu, Leonardo Andrea, Robustelli, Umberto, Piras, Danilo, Serventi, Fernando, Prando, Daniela, Brunelli, Antonio, Zani, Bruno, Pintaldi, Salvatore, Verzelli, Augusto, Mulas, Silvia, Confalonieri, Gianmaria, Spagni, Giuditta, Crucitti, Antonio, Sagnotta, Andrea, Fiume, Stefania, Balestra, Francesco, Gatti, Matteo, Eugeni, Emilio, Carraro, Amedeo, Genna, Michele, Taglietti, Lucio, Azzinnaro, Antonio, Ferfoglia, Stefano, Miranda, Giuseppe, Tirone, Giuseppe, Luparello, Pietro, Berti, Stefano, Tutino, Roberta, De Manzoni Garberini, Andrea, Roscio, Francesco, Maglione, Valeria, Podda, Mauro, Ioia, Giovanna, Cantore, Fabrizio, Mazzalai, Franco, Cortesi, Francesco, Arcuri, Giacomo, Bellanova, Giovanni, Beltramo, Massimo, Chessa, Antonella, Coppola, Massimiliano, Gozzo, Davide, Harbi, Asaf, Minciotti, Edoardo, Pata, Francesco, Pinna, Giovanni, Testini, Mario, Vanella, Serafino, and IPOD study Collaborative Working Group

Published
2017
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6. Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

Author

Aprea Giovanni, Canfora Alfonso, Ferronetti Antonio, Giugliano Antonio, Guida Francesco, Braun Antonio, Battaglini Ciciriello Melania, Tovecci Federica, Mastrobuoni Giovanni, Cardin Fabrizio, and Amato Bruno

Subjects
Surgery, RD1-811
Abstract

Abstract Background Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders. Morphological evaluations performed on serial pre and post – surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ. Methods 62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with: • dyspeptic symptoms questionnaire, • gastric endoscopy with body, antrum, and fundus random biopsies, • histo-pathological analysis of samples and elaboration of bile reflux index (BRI). The same evaluation was repeated at a 6 months follow-up. Results In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori’s gastric colonization nor on the induction of gastric precancerous lesions. Conclusions Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.

Published
2012
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7. GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome

Author

Aprea Giovanni, Ferronetti Antonio, Canfora Alfonso, Cardin Fabrizio, Giugliano Antonio, Guida Francesco, Braun Antonio, Battaglini Ciciriello Melania, Tovecci Federica, Mastrobuoni Giovanni, and Amato Bruno

Subjects
Surgery, RD1-811
Abstract

Abstract Background The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy. In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed. Functional evaluations performed on pre and post – surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier. Methods 45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with: • 24 hours pHmetry, • esophageal manometry, The same evaluation was repeated 1 month and 6 months after surgical intervention. Results In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms. Conclusions The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.

Published
2012
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8. Diverticular disease hospital cost impact analysis: evaluation of testings and surgical procedures in inpatient and outpatient admissions

Author

Aprea Giovanni, Giugliano Antonio, Canfora Alfonso, Cardin Fabrizio, Ferronetti Antonio, Guida Francesco, Braun Antonio, Battaglini Ciciriello Melania, Tovecci Federica, Mastrobuoni Giovanni, and Amato Bruno

Subjects
Surgery, RD1-811
Abstract

Abstract Background Diverticular Disease (DD) is a common condition in Italy and in other western countries. There is not much data concerning DD’s impact on budget and activity in hospitals. Methods The aim is to detect the clinical workload and the financial impact of diverticular disease in hospitals. Retrospective observational study of all patients treated for diverticular disease during the period of seven years in AOU Federico II. Analysis of inpatient and outpatient investigations, treatment, hospitalization and financial refunds. Results A total of 738 patients were treated and 840 hospital discharge records were registered. There were a total number of 4101 hospitalization days and 753 outpatient accesses. The investigations generated were 416 endoscopies, 197 abdominal CT scans, 177 abdominal ultrasound scans, 109 X-rays tests. A total of 193 surgical operations were performed. The total cost of this activity was € 1.656.802 or 0.2% of the total budget of the hospital. € 1.346.218, were attributable to the department of general surgery, 0.9% of the department’s budget . Conclusions The limited impact of diverticular disease on the budget and activity of AOU Federico II of Naples is mainly due to the absence of an emergency department.

Published
2012
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10. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial).

Author

Podda, Mauro, Poillucci, Gaetano, Pacella, Daniela, Mortola, Lorenzo, Canfora, Alfonso, Aresu, Simona, Pisano, Marcello, Erdas, Enrico, Pisanu, Adolfo, Cillara, Nicola, The ACTUAA Study Collaborative Working Group, Serventi, Fernando, Marini, Stefano, Sirigu, Danilo, Piga, Michela, Coppola, Massimiliano, Balestra, Francesco, De Nisco, Carlo, Pazzona, Marco, and Anania, Marco

Abstract

Purpose: The aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography. Methods: The study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively. Results: Of the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08–1.18). Conclusion: Although laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy. Trial registration: Clinicaltrials.gov identifier (NCT number): NCT03080103 [ABSTRACT FROM AUTHOR]

Published
2021
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11. Efficacy and safety of ultrasound-guided placement of central venous port systems via the right internal jugular vein in elderly oncologic patients: our single-center experience and protocol

Author

Canfora, Alfonso, primary, Mauriello, Claudio, additional, Ferronetti, Antonio, additional, Marte, Gianpaolo, additional, Di Maio, Vittorio, additional, Ciorra, Guido, additional, Esposito, Maria Grazia, additional, Giuliano, Maria Elena, additional, Fregola, Giovanni, additional, Barra, Luigi, additional, Cuzzovaglia, Salvatore, additional, Bottino, Vincenzo, additional, and Maida, Pietro, additional

Published
2016
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14. Acute diverticulitis: surgery timing in elderly patients

Author

Aprea, Giovanni, primary, Giugliano, Antonio, additional, Canfora, Alfonso, additional, Ferronetti, Antonio, additional, Guida, Francesco, additional, Ciciriello, Melania Battaglini, additional, Savanelli, Antonio, additional, Cuomo, Rosario, additional, Sarnelli, Giovanni, additional, and Amato, Bruno, additional

Published
2013
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17. Correction to: Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial).

Author

Podda, Mauro, Poillucci, Gaetano, Pacella, Daniela, Mortola, Lorenzo, Canfora, Alfonso, Aresu, Simona, Pisano, Marcello, Erdas, Enrico, Pisanu, Adolfo, Cillara, Nicola, Serventi, Fernando, Marini, Stefano, Sirigu, Danilo, Piga, Michela, Coppola, Massimiliano, Balestra, Francesco, De Nisco, Carlo, Pazzona, Marco, Anania, Marco, and Pulighe, Fabio

Abstract

A Correction to this paper has been published: https://doi.org/10.1007/s00384-021-03862-5 [ABSTRACT FROM AUTHOR]

Published
2021
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18. Predictive factors of intestinal necrosis in acute mesenteric ischemia

Author

Giovanni Aprea, Bruno Amato, Vincenzo Bottino, Antonio Ferronetti, Gianpaolo Marte, Vittorio Maio, Alfonso Canfora, Claudio Mauriello, Pietro Maida, Canfora, Alfonso, Ferronetti, Antonio, Marte, Gianpaolo, Maio, Vittorio Di, Mauriello, Claudio, Maida, Pietro, Bottino, Vincenzo, Aprea, Giovanni, and Amato, Bruno

Subjects
medicine.medical_specialty, predictive factors, Multivariate analysis, Tobacco use, Predic- tive factors, Vessel occlusion, Logistic regression, Gastroenterology, Irreversible trans- mural intestinal necrosi, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Acute mesenteric ischemia, Internal medicine, medicine, cardiovascular diseases, business.industry, General Medicine, Explorative laparotomy, Intestinal necrosis, irreversible transmural intestinal necrosis, Medicine, 030211 gastroenterology & hepatology, Serum lactate, business, acute mesenteric ischemia, Research Article, explorative laparotomy
Abstract

Objectives Acute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory. Methods Registered data of 55 consecutive patients admitted to our center between January 2010 and December 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correlation to its clinical spectre. Results Tobacco use was the most statistically significant (p 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as predictive factors of ITIN in multivariate analysis using logistic regression (OR 49.66 and p-value 0.0021). Conclusion Our univariate and multivariate analysis identified multiple factors (Serum lactate levels ˃ 2mmol/L, Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN.

Published
2019

19. Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score-matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial)

Author

Gaetano Poillucci, Nicola Cillara, Enrico Erdas, M. Pisano, Mauro Podda, S Aresu, Daniela Pacella, Lorenzo Mortola, Alfonso Canfora, Adolfo Pisanu, Podda, Mauro, Poillucci, Gaetano, Pacella, Daniela, Mortola, Lorenzo, Canfora, Alfonso, Aresu, Simona, Pisano, Marcello, Erdas, Enrico, Pisanu, Adolfo, and Cillara, Nicola

Subjects
medicine.medical_specialty, 03 medical and health sciences, 0302 clinical medicine, Multicenter trial, Internal medicine, medicine, Appendectomy, Prospective cohort study, Adverse effect, Uncomplicated appendicitis, business.industry, Clinical outcome, Patient-centered outcomes, Gold standard, Gastroenterology, Hepatology, medicine.disease, Antibiotic treatment, Appendicitis, Multicenter study, Surgery, 030220 oncology & carcinogenesis, Propensity score matching, 030211 gastroenterology & hepatology, business, Conservative treatment
Abstract

Purpose: The aim of this prospective multicenter study was to compare antibiotic therapy and appendectomy as treatment for patients with uncomplicated appendicitis confirmed by ultrasound and/or computed tomography. Methods: The study was conducted from January 2017 to January 2018. Data regarding all patients discharged from the participating centers with a diagnosis of uncomplicated appendicitis were collected prospectively. Results: Of the 318 patients enrolled in the study, 27.4% underwent antibiotic-first therapy, and 72.6% underwent appendectomy. The matched group was composed of 87 patients in both study arms. Of the 87 patients available of 1-year follow-up in the antibiotic-first group, 64 (73.6%) did not require appendectomy. The complication-free treatment success in the antibiotic-first group was 64.4%. A statistically significant higher complication-free treatment success was found in the appendectomy group: 81.8% in the pre-matching sample and 83.9% in the post-matching sample. Patients in the antibiotic-first group reported lower VAS scores compared to those treated with an appendectomy, both at discharge (2.0 ± 1.7 vs 3.6 ± 2.3) and at 30-day follow-up (0.3 ± 0.6 vs 2.1 ± 1.7). The mean of the days of absence from work was higher in the appendectomy group (β 0.63; 95% CI 0.08-1.18). Conclusion: Although laparoscopic appendectomy remains the gold standard of treatment for uncomplicated appendicitis, conservative treatment with antibiotics is a safe option in most cases. Approximately 65% of patients treated with antibiotics are symptom-free at 1 year, without increased risk of adverse events should symptoms recur, and better outcomes in terms of less pain and shorter period of absence from work compared to patients undergoing an appendectomy. Trial registration: Clinicaltrials.gov identifier (NCT number): NCT03080103.

Published
2021

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